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My name is Patrik Hutzel from Intensive Care at Home at intensivecareathome.com, where we provide tailor-made solutions at home for long-term ventilated adults and children with tracheostomies, tailor-made solutions at home for long-term ventilated adults and children on BiPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure) without tracheostomy, for adults and children with tracheostomy without ventilation, home ventilation weaning, home tracheostomy weaning, home cough assist management, home TPN (Total Parenteral Nutrition), home IV fluids, home IV antibiotics, home IV potassium, magnesium, and other electrolyte infusions, home central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line, and port management at home. We also provide SPC (Suprapubic Catheter) and IDC (Indwelling Catheter) management at home, nasogastric tube and nasojejunostomy tube, as well as PEG (Percutaneous Endoscopic Gastrostomy) and PEJ (Percutaneous Endoscopic Jejunostomy) tube management at home. We also provide palliative care services at home, as well as Level 2 and Level 3 NDIS (National Disability Insurance Scheme) support coordination and WorkSafe case management.

 

Today I have an email from David, who wrote to me and I have also been on a phone call with David — but I want to share his message because I know so many of you are living through exactly this right now.

David says:

 

“Hi Patrik, 

I am looking and interested in getting some advice about my wife who has been on a ventilator with a tracheostomy since March 2026 and has lately been getting pneumonia in ICU. I want to take my wife home with 24-hour nursing care — not just for a day, but for as long as she needs it. I need a 24-hour critical care nurse similar to ICU, but also an assistant or a carer who can help the nurse and do any of the domestic duties, because it is simply getting too much for me, so that my wife can heal and recover. ICU worked well for a while, but now she is sort of recovering and then getting pneumonia again, because she is just in hospital where there are infections everywhere. I am simply exhausted and I do not know how much longer I can keep up with her in ICU. I want to try and get my wife home. She will be better in our home with good and well-experienced 24-hour critical care nurses and a support worker or support workers. Patrik, I need your advice and help on how to get my wife home.”

 

David, I really appreciate that you are trusting me with this question. Before I answer, you might be wondering what makes me qualified to answer questions like this. I have worked in critical care nursing for over 25 years, where I worked as a nurse manager in ICU for over five years. I have been setting up intensive care at home in Australia since 2012 — that is how long we have been operating — and I was also part of setting up Intensive Care at Home in Germany in the early 2000s, so I have been very familiar with the concept, having also worked in ICU for decades.

 

We are also providing consulting and advocacy for families in intensive care, and you can find out more information at intensivecarehotline.com.

 

The Clinical Picture: Tracheostomy and Recurring Pneumonia

David, what you are describing — your wife on a ventilator with a tracheostomy, recurring pneumonia in ICU, and a husband who is simply running on empty — is one of the most common situations we hear about, and it is absolutely something we can work through together to help you get your wife home with 24-hour critical care nurses.

 

Let’s break down what is likely going on clinically, why recurring pneumonia keeps happening in ICU, and what your real options are for bringing your wife home safely — for the long term, for however long she needs it — assuming she is not able to come off the ventilator in ICU.

 

When someone has been ventilator-dependent with a tracheostomy since March 2026 and is now cycling in and out of pneumonia, there are usually a few things happening at once.

 

Number one: secretions are pooling because suctioning is not frequent enough, thorough enough, or skilled enough.

 

Micro-aspiration is occurring around the tracheostomy cuff, seeding the lungs with bacteria.

 

Immobility and inconsistent chest physiotherapy are allowing secretions to settle in the lower lobes — that means your wife needs to be mobilized and needs to get out of bed regularly.

 

And cross-infection risk is much higher in an ICU with rotating staff and other very sick patients nearby — you do not have that at home.

This pattern of improve, relapse, improve, relapse is extremely common in long-term ICU patients on a ventilator with a tracheostomy. It is exactly why families like yours start asking whether home could actually be the safer option, not just the more comfortable one for your wife, but also for yourself, because you have shared so vividly that you are running on empty.

 

Why Does This Keep Happening in a Long-Term ICU Setting?

It is not that ICUs do not have skilled staff. It is a structural problem. ICUs are overworked and not really equipped to look after long-term patients, because what long-term patients need is regular teams, consistency, and a familiar environment — and they do not get that in ICU. Today it might be nurse Mary, next week it might be someone else altogether — there is no consistency. Whereas at home, one of our goals is always to achieve consistency of staff.

Because of that inconsistency of staff, they do not always know your wife’s baseline. Suctioning, repositioning, chest physiotherapy, and mobilization are often built around the ICU schedule — not around your wife’s schedule. At home, we would do that around your wife’s schedule.

 

Add into this mix a shared airspace with other very unwell patients full of bacteria and infections, and recurring pneumonia becomes almost predictable rather than surprising. It is at the very core of what I have been saying for years: many of these patients do not need to be in an ICU or a facility at all. They need one-on-one, dedicated critical care registered nursing support — and that can be delivered safely at home.

 

What Actually Reduces Recurring Pneumonia

If the goal is to stop the pneumonia cycle and let your wife properly heal, the treatment approach needs to include:

 

One: one-on-one, 24/7 CCRN (Critical Care Registered Nurse) care with ICU nurses every shift, so airway management is consistent and proactive rather than reactive — similar to an ICU, but delivered at home.

 

Two: rigorous, skilled tracheostomy and ventilator management, including cuff pressure checks and secretion clearance.

 

Three: structured chest physiotherapy and mobilization — not just as-needed suctioning.

 

Four: a single, familiar care team who knows your wife’s baseline and can catch deterioration early and manage it before it becomes another pneumonia.

This is precisely the model we use for evidence-based home mechanical ventilation, which you can read about in full on our website at intensivecareathome.com. I will put a link to the evidence-based Mechanical Home Ventilation Guidelines in the show notes.

 

Get Access to Medical Records

David, before you make any decisions, request your wife’s full medical records from the hospital — nursing notes, doctor’s notes, vital signs, ventilation charts, suctioning frequency, vital sign trends, specialist reports, CT scan reports, MRI scan reports, chest X-ray results, lab results including arterial blood gases, medication charts, and fluid balance charts. Leave no stone unturned, because this will show you exactly what is driving the recurring pneumonia and gives you leverage when you raise the option of supported discharge home.

 

Do not accept “she can’t go home” as a final answer without seeing the data yourself and getting an independent opinion. I can hands-on guide you through working through her medical records with my team, questioning her current treatment plan, and most importantly, planning a safe discharge home.

 

You can reach me directly at intensivecareathome.com by calling us on one of the numbers on the top of our website, or for our Australian audience, you can call me directly on my mobile on 0410 942 230 — that is again 0410 942 230. You can also call internationally if you are in the US (United States), in Canada, in the UK (United Kingdom), or in India — and if you are interested in Intensive Care at Home, please reach out to us. We can help you there as well.

 

Why Intensive Care at Home Is Built for Situations Like Your Wife’s

David, your wife’s situation is exactly the kind of situation I built Intensive Care at Home for. We provide a genuine alternative to a long-term stay in intensive care. We provide 24/7, one-on-one, critical care registered nursing at home for adults and children on invasive ventilation with tracheostomy, non-invasive ventilation such as BiPAP and CPAP without tracheostomy, and tracheostomy care without ventilation — not for a day, but for as long as your wife needs it.

 

Right now in 2026, we are the only Intensive Care at Home nursing provider in Australia that is third-party accredited to ISO 9001:2015 and also NDIS registered for Intensive Care at Home. We have been the only provider in Australia that has been third-party accredited for Intensive Care at Home nursing since 2012. There is no other provider in Australia that has achieved that high level of accreditation. You can find our full accreditation and quality details on our website at intensivecareathome.com/accreditation-quality.

 

With a dedicated 24/7 critical care nursing team at home — rather than a rotating roster of unfamiliar staff as in ICU — your wife gets consistent, skilled airway, ventilator, and tracheostomy management every single shift, 24/7. That is the single biggest factor in breaking the recurring pneumonia cycle.

 

The Bottom Line

David, recurring pneumonia in an ICU on a ventilator and tracheostomy is a sign that the current care model is not matching your wife’s needs — and it is definitely not matching your needs either. It does not mean she is unable to recover at home. With the right one-on-one, 24/7 CCRN care model in place, home is very often the safest, most healing, and most holistic environment.

 

Get her medical records, get an independent opinion, and let’s take the next steps about what a safe discharge home would look like for her. If you are wondering who is going to pay for it — an ICU bed costs between $5,000 to $10,000 per bed day. Intensive Care at Home costs half of that. Whether it is NDIS, private health insurance, the Department of Health, or the hospital directly — someone has an interest in cutting the cost of the ICU bed by 50%, and we are here to help you all the way along to work this out and make it happen.

 

With all of that said, with Intensive Care at Home, we are currently sending our critical care nurses into the home 24 hours a day. Therefore, we are providing a genuine alternative to long-term stay in intensive care for:

• Ventilation
• Tracheostomy
• Home BiPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure)
• Tracheostomy care without ventilation
• home TPN (Total Parenteral Nutrition)
• Home IV potassium
• Home IV magnesium
• Home IV antibiotics
• Home IV fluids

We’re providing:

• Cough assist management at home
• Ventilation weaning management at home
• central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line as well as port management at home
• nasogastric tube, nasojejunostomy tube, PEG (Percutaneous Endoscopic Gastrostomy), PEJ (Percutaneous Endoscopic Jejunostomy) tube management at home
• IDC (Indwelling Catheter) and SPC (Suprapubic Catheter) management at home
• Palliative care services at home

 

We’re also sending our critical care nurses into the home for emergency department bypass services. We have done so successfully as part of the Western Sydney Local Health District’s In Touch program, saving approximately $2,000 per patient that we keep at home instead of them going into an emergency department.

 

That also means we’re in a position to cut the cost of an ICU bed by around 50%. An intensive care bed costs between $5,000 to $10,000 per bed day depending on location. Intensive Care at Home costs approximately 50% of that, and we’re freeing up the most sought-after bed in the hospital, which is the ICU bed. Most importantly, we’re improving the quality of life for patients and their families, which is a win-win situation for all stakeholders.

 

Our Coverage and Accreditation

With Intensive Care at Home, we’re currently operating all around Australia, in all major capital cities, as well as in all regional and rural areas. We are an NDIS approved service provider all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria as well as the Department of Veterans Affairs all around Australia.

 

We’re also ISO 9001:2015 accredited. Our clients and we as a service provider have also received funding through public hospitals, private health funds as well as departments of health.

 

We are the only service provider in Australia that has achieved third-party accreditation for Intensive Care at Home nursing in 2025. We have been achieving this high level of accreditation since 2012. No other provider in Australia has achieved the Intensive Care at Home level of accreditation in the community and has created more intellectual property when it comes to Intensive Care at Home nursing than we have.

 

This puts us in a position to employ hundreds of years of critical care nursing experience combined in the community. No other service provider in 2025 employs a higher skill level in the community than we do. And that enables us to look after the highest acuity adults and children in the community in Australia safely.

 

If You Need Help

If you’re at home already and you’re watching this or you’re stuck in an ICU and you realize that you don’t have the right level of support, I can give you many examples where we helped clients with funding, how we advocate for funding. We had to advocate successfully for funding from our first case study to many other case studies where we had to advocate successfully for funding with the right evidence of course because it is crystal clear that disability support workers for example or registered nurses without ICU experience cannot look after ventilated clients at home whether adults or children with or without a tracheostomy and it’s simply dangerous and negligent.

 

There are plenty of examples where clients with support worker models or even RN (registered nurse) models without ICU experience have died at home and I have evidence to back up everything that I’m saying here because it’s a bit like flying the airplane with a cabin crew instead of the pilot and it could simply be deadly.

 

This can be avoided by having simply 24-hour critical care nurses at home because our clients are at high risk of medical emergencies or worse without critical care nurses 24 hours. This is actually also evidence-based in the community and is documented in our evidence-based Mechanical Home Ventilation Guidelines on our website at intensivecareathome.com.

 

Think about it: in an intensive care unit in a hospital, you wouldn’t have support workers or general registered nurses looking after a critical care patient on a ventilator with a tracheostomy. So why would anyone in their right mind do that in a home care environment where there are fewer resources?

 

Clients that have found us have been at home long-term predictably and permanently with critical care nurses. Their alternative would have been to either die or stay in ICU long-term, and our clients don’t go back to ICU. They stay at home permanently and predictably and the insurance bodies save half of the cost of an ICU. But it’s a win-win situation all around.

 

We can do the same for you if you’re stuck in ICU or if you’re not safe at home, which includes the advocacy for funding and the network that goes along with it. We have always successfully advocated for our clients or we have the network to successfully advocate for you and for your family member, otherwise we wouldn’t be in business. The same again is applicable for those stuck in an ICU which is similar to many of our, if not most of our cases.

 

Our Support Coordination Services

This is also why we are providing Level 2 and Level 3 NDIS support coordination. We have a team of experienced NDIS support coordinators, and they have a wealth of knowledge. We’re also providing TAC case management and WorkSafe case management in Victoria with Lucy McCotter.

 

If you’re an NDIS support coordinator or a case manager or a social worker from another organization or a hospital watching this and you’re looking for nursing care for your participants, please reach out to us as well. If you’re looking for funding for nursing care for your participants and you don’t know how to go about it and how to advocate for it, what evidence to provide, I encourage you to reach out to us as well. We have the network to make that happen. We will help you with the right level of funding and with the right level of advocacy.

 

We’re also providing NDIS specialist nursing assessments done by critical care nurses with a legal nurse consulting background.

 

Join Our Team

If you are a critical care nurse and you’re looking for a career change and you want to join a very progressive, dynamic, successful, and high-performing team of critical care nurses in the community, we are employing hundreds of years of critical care nursing experience combined.

 

If you’re looking for a career change, we’re currently hiring for jobs for critical care nurses in Melbourne, Sydney, Brisbane, Albury-Wodonga, Bendigo, Geelong, Warragul, and also in Wyelangta in Victoria.

 

If you have worked in critical care nursing for a minimum of two years, adult ICU, pediatric ICU, ED and you have already completed a postgraduate critical care nursing qualification, we will be absolutely delighted hearing from you.

I have a disclaimer though: Because we are offering tailor-made solutions for our clients which includes regular staff, our clients do also want the same staff coming over and over again because they are so vulnerable and so special. That’s why we need regular, reliable staff.

 

If you’re looking for agency work where you can come and go, this will not be the right fit for you. We’re looking for consistency and our clients are looking for consistency. So please only apply with us if you can give us regular and consistent availabilities for shifts and you’re really keen on building relationships with us and with our clients. Reliability is also a must.

 

For Medical Professionals and Healthcare Executives

If you’re an intensive care specialist or an ED specialist, we also want to hear from you. We’re currently expanding our medical team as well.

 

We can also help you eliminate your bed blocks in your ICU and in your ED for your long-term patients or for your regularly readmitting patients with our critical care nursing team at home. We’re here to help to take the pressure off your ICU and ED beds. In most cases, you won’t even pay for it. Even if you do pay for it, it is so much more cost-effective than what you’re paying for in ICU and ED settings, and you get the same level of care and simply more patient and family satisfaction because you also want to partner with your consumers.

 

If you are a hospital executive watching this, we can help you free up your ICU and ED beds.

 

International Support

If you’re in the U.S. or in the UK and you’re watching this and you need help, we want to hear from you as well. We can help you there privately with one-on-one consulting and with hiring nurses privately.

 

Once again, our website is intensivecareathome.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected].

 

If you like my videos, click the like button, subscribe to my YouTube channel for regular updates for families with Intensive Care at Home and intensive care. Click the like button, click the notification bell, and share this video with anyone who has a family member in intensive care long-term or needs to see this.

Thank you so much for watching.

 

This is Patrik Hutzel from intensivecareathome.com and I’ll talk to you in a few days.

 

Take care for now.